Cancers. Certain cancers can cause immune suppression, particularly those which involve the blood cells which are so crucial to our immune system. Lymphomas, leukaemias and myeloma are the cancers which may suppress the immune system.

Not having a spleen, due to it having been removed. Or having a spleen which does not work well. This can occur due to certain conditions such as sickle cell anaemia,thalassaemia major or lymphoma, or after radiotherapy.

Which specific medicines cause immune suppression?

Oral steroids are a common offender and are used in numerous conditions. When used at high doses for long periods of time they can cause immune suppression. Lower doses do not generally cause a problem. For an adult, a dose of 40 mg per day of prednisolone for more than a week may cause immune suppression, but this dose varies for other steroids and for children. See separate leaflet called Oral Steroids for more information.

Monoclonal antibodies - of which there are many ending in "mab", such as bevacizumab, rituximab and trastuzumab.

Anti-TNF drugs such as etanercept, infliximab, adalimumab, certolizumab and golimumab. (TNF stands for anti tumour necrosis factor, and some of the "mab" medicines above act against TNF, so there is some overlap in groups of medicines here.)

Why would the spleen be removed?

Your spleen is an important part of your immune system but sometimes it has to be removed, with an operation called a splenectomy. This may need doing if you are involved in an accident, or have an injury where your spleen is ruptured. It may need removing to stop you losing vast quantities of blood.

Sometimes it has become too large and destroys too many of your blood cells. Examples where this occurs and the spleen may need to be removed include:

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